Janie Hemphill’s Blog

Nakpanduri, Sunday night call

I have been starting every morning at 7:30 in the pediatrics ward. First I see babies who have IVs with a nurse at my side to translate and take orders back to the desk. The ward is a very large room with no curtains or separation between beds. Each mother sits on a wood stool beside her child’s bed, or rests on the floor. There are pots and pans in or under most of the beds. Each patient has to have a family member bringing them food because the hospital does not make meals. Diapers aren’t used, so each bed is covered with a thin sheet of plastic. Some beds don’t have rails, and I’ve seen two babies roll off their beds when their mothers stepped away. The IV fluids are in glass bottles and hang upside down in cloth slings above the beds. There’s no need to calculate infusion rates. We just order them as “moderate” or “slow”. I think every patient I saw this morning had been admitted for malaria, and about one third of them had hematocrits in the teens and received transfusions. For a child to receive a transfusion, a family member has to go to the lab to have the blood drawn and then carry the bag back to the ward. Most of the children recover very well with quinine. Some are too ill when they are admitted to make a recovery. I had just examined a very sick baby the other day and was 10 beds down the line when I looked up and saw that it had been taken from its bed because it had died.

After rounds Saturday morning I was able to get away with a group that was going to the town of Nakpanduri to spend time at the Gambaga Escarpment. We took a trail about a quarter mile from the road and found the large rocks that are high above the plain. I needed some help getting up there because of the height, but it was worth conquering my fear because the view was amazing. We sat there for 40 minutes or so and left when we heard thunder. I have seen the rain here twice, and it is a downpour every time.

Sunday I split call with Heather, the family practice resident who is staying in House 7 with me. We finished late rounds through all the wards about 9pm and came back to the house. If there is anything urgent, a nurse will ride a motorbike to our house to get us. Or if there’s a routine admission that just needs orders signed, we can take care of it without having to walk the trails in the dark. At about 10:30, just as I shut off the shower, I heard a frantic-sounding nurse say to Heather, “Car accident. 20 people.” We grabbed our flashlights and got another resident and student to go with us to the hospital. There were 3 patients on stretchers in the hallway by the procedure rooms that had gashes on their faces and knees that we ended up stitching that night. Several had broken wrists. One had a dislocated hip. Just beyond the doors leading to the wards was a lady that had died. I had another student run with me to get Dr. Faile from his house, and we also got a visiting OB-Gyn doctor to come help. There was a row of patients with minor injuries in the hallway when we got back.  While we were putting stitches in one lady, Elisabeth Faile stood by her side and translated for us. We learned that they were all market women who had been to the Nakpanduri market that day.

I was asleep by 1:30am, on the couch so I could hear the nurses knock. The only knock came at 3am. She needed an order for anti-venom and clot time and for me to get an ASV vile for her since the pharmacy is closed at night. I followed the trail to House 6 and got a vile from their fridge.  It’s very convenient to have it close by.

Monday was clinic day. My first patient had an eyebrow laceration from a bike accident. So the first hour of clinic I spent stitching him up in the procedure room. The rest of the day I saw a total of 43 patients and left the hospital at 6:45pm.